MEDICARE: ENRIQUE AGUSTIN CASTRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1831691377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE AGUSTIN CASTRO

Provider Business Mailing Address
First Line	:	5924 SOFT MIST CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-6706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5924 SOFT MIST CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-6706
Country	:	US
Telephone Number	:	702-308-8280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	03/26/2019

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Directions to “ ENRIQUE AGUSTIN CASTRO ” Practice Location

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